Lyme Arthritis in Rheumatological Practice: A Survey of Canadian Pediatric Rheumatologists

Objectives Arthritis is a common manifestation of Lyme disease (LD) in children and resembles other forms of inflammatory arthritis including JIA. Up to 15% of children with Lyme arthritis (LA) have persistent arthritis despite adequate antibiotic therapy, called post-infectious LA (PILA), and present diagnostic and treatment challenges. The impact of LA is likely to grow with the predicted increase in incidence and geographic distribution of LD.[1,2] The study’s objective was to gain an understanding of the clinical burden, clinical practices, and research priorities of Canadian pediatric rheumatologists (PRs) in caring for children with LA. Methods An online survey was distributed to all PRs identified through the Canadian Rheumatology Association membership directory in May 2024. We collected information on practice characteristics, models of care, management, and research priorities regarding LA. Descriptive statistics are reported. Results 40/69 PRs (58%) responded; 80% (32/40), reported caring for patients with LA. PRs in the Atlantic and Eastern regions see the most LA (Table 1). 56% of respondents feel that PRs should assess the response to the first course of antibiotics; 26% would involve PRs only after another health care provider determines incomplete response to the first course of antibiotics, 3% only in a patient diagnosed with PILA, and 23% depending on other factors, primarily non-PRs musculoskeletal examination abilities. Following the first course of antibiotics, in children who have improved, but have persistent symptomatic arthritis, 66% (21/32) would recommend a 2nd course of oral antibiotics; 16% (5/32) would recommend an intraarticular steroid injection (IAS) (4 with antibiotics, 1 alone); and 19% (6/32) were unsure/didn’t respond. In children with minimal/no response to the first course of antibiotics, the top responses were divided between a 2nd course of oral antibiotics (9/32), IV antibiotics (9/32) or an IAS with antibiotics (9/32). The top priorities identified for research were to (1) determine optimal treatment for patients who do not fully respond to the first course of antibiotics, (2) define optimal models of care, and (3) develop tests to aid in the diagnosis of LA and differentiate it from other forms of arthritis. Table 1 Demographics, practice characteristics, and selected additional survey responses Conclusion Children with LA are seen by PRs across Canada however models of care vary and there is variability in treatment approaches. We have identified research priorities including determining optimal treatment in those who do not respond to the first course of antibiotics and exploring models of care which will allow timely access to high-quality care. [1.] Clow K. PLoS One 2017;12(12):e0189393. [2.] Murison K. PLoS One 2023;18(12):e0295909.

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